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Evaluating the contributions of strategies to prevent SARS-CoV-2 transmission in the healthcare setting: a modelling study

INTRODUCTION: Since its onset, the COVID-19 pandemic has caused significant morbidity and mortality worldwide, with particularly severe outcomes in healthcare institutions and congregate settings. To mitigate spread, healthcare systems have been cohorting patients to limit contacts between uninfecte...

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Autores principales: Qiu, Xueting, Miller, Joel C, MacFadden, Derek R, Hanage, William P
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7929641/
https://www.ncbi.nlm.nih.gov/pubmed/33653758
http://dx.doi.org/10.1136/bmjopen-2020-044644
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author Qiu, Xueting
Miller, Joel C
MacFadden, Derek R
Hanage, William P
author_facet Qiu, Xueting
Miller, Joel C
MacFadden, Derek R
Hanage, William P
author_sort Qiu, Xueting
collection PubMed
description INTRODUCTION: Since its onset, the COVID-19 pandemic has caused significant morbidity and mortality worldwide, with particularly severe outcomes in healthcare institutions and congregate settings. To mitigate spread, healthcare systems have been cohorting patients to limit contacts between uninfected patients and potentially infected patients or healthcare workers (HCWs). A major challenge in managing the pandemic is the presence of currently asymptomatic/presymptomatic individuals capable of transmitting the virus, who could introduce COVID-19 into uninfected cohorts. The optimal combination of personal protective equipment (PPE), testing and other approaches to prevent these events is unclear, especially in light of ongoing limited resources. METHODS: Using stochastic simulations with a susceptible-exposed-infected-recovered dynamic model, we quantified and compared the impacts of PPE use, patient and HCWs surveillance testing and subcohorting strategies. RESULTS: In the base case without testing or PPE, the healthcare system was rapidly overwhelmed, and became a net contributor to the force of infection. We found that effective use of PPE by both HCWs and patients could prevent this scenario, while random testing of apparently asymptomatic/presymptomatic individuals on a weekly basis was less effective. We also found that even imperfect use of PPE could provide substantial protection by decreasing the force of infection. Importantly, we found that creating smaller patient/HCW-interaction subcohorts can provide additional resilience to outbreak development with limited resources. CONCLUSION: These findings reinforce the importance of ensuring adequate PPE supplies even in the absence of testing and provide support for strict subcohorting regimens to reduce outbreak potential in healthcare institutions.
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spelling pubmed-79296412021-03-05 Evaluating the contributions of strategies to prevent SARS-CoV-2 transmission in the healthcare setting: a modelling study Qiu, Xueting Miller, Joel C MacFadden, Derek R Hanage, William P BMJ Open Public Health INTRODUCTION: Since its onset, the COVID-19 pandemic has caused significant morbidity and mortality worldwide, with particularly severe outcomes in healthcare institutions and congregate settings. To mitigate spread, healthcare systems have been cohorting patients to limit contacts between uninfected patients and potentially infected patients or healthcare workers (HCWs). A major challenge in managing the pandemic is the presence of currently asymptomatic/presymptomatic individuals capable of transmitting the virus, who could introduce COVID-19 into uninfected cohorts. The optimal combination of personal protective equipment (PPE), testing and other approaches to prevent these events is unclear, especially in light of ongoing limited resources. METHODS: Using stochastic simulations with a susceptible-exposed-infected-recovered dynamic model, we quantified and compared the impacts of PPE use, patient and HCWs surveillance testing and subcohorting strategies. RESULTS: In the base case without testing or PPE, the healthcare system was rapidly overwhelmed, and became a net contributor to the force of infection. We found that effective use of PPE by both HCWs and patients could prevent this scenario, while random testing of apparently asymptomatic/presymptomatic individuals on a weekly basis was less effective. We also found that even imperfect use of PPE could provide substantial protection by decreasing the force of infection. Importantly, we found that creating smaller patient/HCW-interaction subcohorts can provide additional resilience to outbreak development with limited resources. CONCLUSION: These findings reinforce the importance of ensuring adequate PPE supplies even in the absence of testing and provide support for strict subcohorting regimens to reduce outbreak potential in healthcare institutions. BMJ Publishing Group 2021-03-02 /pmc/articles/PMC7929641/ /pubmed/33653758 http://dx.doi.org/10.1136/bmjopen-2020-044644 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Public Health
Qiu, Xueting
Miller, Joel C
MacFadden, Derek R
Hanage, William P
Evaluating the contributions of strategies to prevent SARS-CoV-2 transmission in the healthcare setting: a modelling study
title Evaluating the contributions of strategies to prevent SARS-CoV-2 transmission in the healthcare setting: a modelling study
title_full Evaluating the contributions of strategies to prevent SARS-CoV-2 transmission in the healthcare setting: a modelling study
title_fullStr Evaluating the contributions of strategies to prevent SARS-CoV-2 transmission in the healthcare setting: a modelling study
title_full_unstemmed Evaluating the contributions of strategies to prevent SARS-CoV-2 transmission in the healthcare setting: a modelling study
title_short Evaluating the contributions of strategies to prevent SARS-CoV-2 transmission in the healthcare setting: a modelling study
title_sort evaluating the contributions of strategies to prevent sars-cov-2 transmission in the healthcare setting: a modelling study
topic Public Health
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7929641/
https://www.ncbi.nlm.nih.gov/pubmed/33653758
http://dx.doi.org/10.1136/bmjopen-2020-044644
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